Editorial: Trust between community and rural providers is crucial

Later this month, some residents of Albert Lea, Minn., a town of just over 18,000 people about 90 miles from the Twin Cities, will go head to head with the town's largest employer, Mayo Clinic Health System.

After nearly a year of dialogue—some of it mediated—a group of residents and elected officials say they're done trying to persuade Mayo to keep inpatient and intensive-care services, major surgeries and childbirth at its Albert Lea Medical Center, services that system officials said they would move to a hospital 21 miles away.

Instead, community leaders are trying to attract providers to compete with Mayo. And they have some ammunition—a recent report from Quorum Health Resources that cautiously states that a small, full-service hospital meeting a list of conditions could be viable.

“We have the highest health insurance rates in Minnesota. Mayo doesn't have competition here. If we can bring another healthcare facility into town and it lowers premiums and costs, it's a win-win. We're taking control of our healthcare,” said Brad Arends, co-chair of Save Our Hospital. He said there are three interested providers but declined to name them.

The situation playing out in Albert Lea should be a warning to any hospital operator considering consolidation that emotions over the loss of local healthcare run deep.

Mayo officials admit that they should have invited community leaders to participate in conversations about the future of local healthcare. At the same time, residents, even ones as well informed as those in Albert Lea, must realize that many of the innovations taking place in care delivery are in response to the high costs every patient and payer around the country complains about.

In several best-case scenarios described in this special report, hospital operators' business acumen, combined with community leaders' economic vision, worked together to create policies and plans that would address the needs of current and future patient populations.

In Mayo's situation, CEO Dr. John Noseworthy said Albert Lea suffered the same revenue losses and staffing shortages that have caused other rural hospitals to close. He said Mayo was duplicating some of its most complex and expensive services in neighboring communities. So they would transfer inpatient and intensive-care services, major surgeries and childbirth to its Austin, Minn., campus. In return, Mayo is moving inpatient psychiatric services from Austin to Albert Lea and investing millions in both facilities.

“No one has lost their job. We continue to invest heavily in the community and we want the community to be strong,” Noseworthy said, underscoring a point that's important for tax-exempt systems to make as their ability to skirt state and local taxes is scrutinized by cash-strapped governments.

“It's hard to take what Mayo says at face value,” said Jennifer Vogt-Erickson, spokeswoman for Save our Hospital. She believes Mayo's motivation was all fiscal and that Austin was attractive because it's home to Hormel, which has made huge donations to Mayo in recent years.

Despite a misstep earlier this year in which Noseworthy said the system should prioritize patients with private insurance over Medicaid and Medicare, the retiring leader has maintained a commitment to mission over margin. Still, the lack of trust remains.

“Simply stated, it's imperative that hospital executives be transparent about their plans,” said Paul Keckley, an industry consultant and managing editor of the Keckley Report. “Community leaders see a resource jeopardized by consolidators who place their interests above patients.”

Mayo, for one, has learned its lesson.

Last month, Albert Lea and Austin introduced a new healthcare delivery model that will involve telemedicine and on-site nurse practitioners. Those changes came out of listening sessions with the community.

“We hope to remain the preferred provider in the area,” said Dr. Annie Sadosty, regional vice president of Mayo's southeast Minnesota operations.